Noninvasive mechanical ventilation with helmet in patients with exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial

Keywords: helmet; face mask; noninvasive mechanical ventilation; chronic obstructive pulmonary disease (COPD)


Objective ‒ to compare the incidence of complications and the main treatment outcomes of non-invasive mechanical ventilation (NIV) with a helmet versus NIV with a full face mask.
Materials and methods. A monocentric randomized open-labeled controlled clinical trial. Patients with exacerbation of chronic obstructive pulmonary disease (COPD) with signs of respiratory failure were randomized to receive NIV through a mask or helmet. The study included 59 patients who were randomized into two groups: NIV through helmet (n = 29) or mask (n = 30). The average age of the patients was (59.24 ± 14.20) and (59.06 ± 15.90) years, respectively. In both groups men predominated ‒ 23 (79 %) and 27 (90 %) respectively. Ventilation was performed with a Draeger Carina apparatus in pressure support (PS) mode. The primary endpoint was the cumulative incidence of NIV complications. Secondary endpoints were PaO2/FiO2 ratio, tolerance to therapy, frequency of intubations, duration of stay in the intensive care unit (ICU), and ICU mortality. A total of 59 patients were involved in the study.
Results. The complication rate was lower in the helmet group (10 % (n = 3) versus 43 % (n = 13), p = 0.004) and the PaO2/FiO2 ratio was higher at the first hour and at the end of NIV (253.14 ± 64.74) mm Hg versus (216.06 ± 43.86) mm Hg and (277.07 ± 84.89) mmHg versus (225.81 ± 63.64) mm Hg, p = 0.013 and p = 0.012) compared with NIV through a full face mask. More patients noted excellent helmet tolerance than masks at the 4th hour of therapy (24 (83 %) versus 14 (47 %), p = 0.004) and at the end of ventilation (69 % (20/29) versus 30 % (9/30), p = 0.03). One patient was unable to continue therapy due to mask intolerance. Differences in intubation rates, length of ICU stay, and mortality were statistically insignificant (p = 0.612, p = 0.100, p = 1.000 respectively).
Conclusions. NIV through a helmet can reduce the incidence of complications and increase the PaO2/FiO2 ratio, as well as improve tolerance compared to NIV through a face mask in patients with exacerbation of COPD. A larger scale of study is needed to establish the effect of interface choice on ICU mortality, time spent in ICU, and frequency of intubation.


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Halpin DMG, Celli BR, Criner GJ et al. The GOLD Summit on chronic obstructive pulmonary disease in low- and middle-income countries. Int J Tuberc Lung Dis. 2019;23(11):1131-41.

Mathers CD, Loncar D. Projections of global morta-lity and burden of disease from 2002 to 2030. PLoS Med. 2006;3(11):e442.

Lange P, Celli B, Agusti A et al. Lung-function trajectories leading to chronic obstructive pulmonary disease. N Engl J Med. 2015;373(2):111-22.

Global Initiative for Chronic Obstructive Lung Di-sease. Available from, published in Fontana, WI, USA.

Wedzicha J, Miravitlles M, Hurst JR, Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. European Respiratory Journal. 2017;49(3):1600791.

Nakaz Ministerstva ohoroni zdorov’ya Ukrayini N 555 27.06.2013. (In Ukrainian).

DuBose JJ et al. The relationship between post-traumatic ventilator-associated pneumonia outcomes and American College of Surgeons trauma centre designation. Injury. 2011;42:40-3.

Tyburski JG, Collinge JD, Wilson RF, Eachempati SR. Pulmonary contusions: Quantifying the lesions on chest X-ray films and the factors affecting prognosis. J Trauma. 1999;46:833-8.

Gunduz M, Unlugenc H, Ozalevli M, Inanoglu K, Akman H. A comparative study of continuous positive airway pressure (CPAP) and intermittent positive pressure ventilation (IPPV) in patients with flail chest. Emerg Med J. 2005;22:325-9.

Mishra SP, Mishra M, Bano N, Hakim M Z. Management of traumatic flail chest in intensive care unit: An experience from trauma center ICU. Saudi J Anaesth. 2019;13:179-83.

Hernandez G et al. Noninvasive ventilation reduces intubation in chest trauma-related hypoxemia: A randomized clinical trial. Chest. 2010;137:74-80.

Antonelli M et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: A multi-center study. Intensive Care Med. 2001;27:1718-28.

Non-invasive ventilation in acute respiratory failure. Thorax. 2002;57:192-211.

Rochwerg B et al. Official ERS/ATS clinical practice guidelines: Noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50(2):1602426.

Udekwu P, Patel S, Farrell M, Vincent R. Favorable outcomes in blunt chest injury with noninvasive bi-level positive airway pressure ventilation. Am J Surg. 2017;83:687-95

Antonelli M et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med. 1998;339:429-35.

Duggal A, Perez P, Golan E, Tremblay L, Sinuff T. Safety and efficacy of noninvasive ventilation in patients with blunt chest trauma: A systematic review. Crit Care. 2013;17:R142.

Lemyze M et al. Rescue therapy by switching to total face mask after failure of face mask-delivered noninvasive ventilation in do-not-intubate patients in acute respiratory failure. Crit Care Med. 2013;41:481-8.

Pisani L et al. Oronasal mask versus helmet in acute hypercapnic respiratory failure. Eur Respir J. 2015;45:691-9.

Özlem ÇG, Ali A, Fatma U, Mehtap T, Şaziye Ş. Comparison of helmet and facial mask during noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease: A rando-mized controlled study. Turk J Med Sci. 2015;45:600-6.

Liu Q, Gao Y, Chen R, Cheng Z. Noninvasive ventilation with helmet versus control strategy in patients with acute respiratory failure: A systematic review and meta-analysis of controlled studies. Crit Care. 2016;20:265.

Patel BK, Wolfe KS, Pohlman AS, Hall JB, Kress JP. Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: A randomized clinical trial. JAMA. 2016;315:2435-41.

How to Cite
Glumcher, F., & Dyomin, Y. (2020). Noninvasive mechanical ventilation with helmet in patients with exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial. Ukrainian Interventional Neuroradiology and Surgery, 34(4), 60-69.